Hi Dr Park, If nitric oxide produced in the nasal area is not getting inhailed due to stuffiness or bypassed like Dr Jones" hole in neck" Is their a therapy to replace what is normally produced?Good Sleep, Chris

Dr. Parks,
Could you explain Sleep/Wake perception disorders? Over the past 25 or so years there have been the occasional patients that want to argue to the death that they never fell asleep during their polysomnogram. The patients truly believe they never slept. All Stages REM, NREM and brief REM was observed. I had another patient such as this a few days ago.

Dr. Park when scoring an arousal we know it has to be at least 3 seconds. Is there a maximum duration?

Dr. Parks.
Would we see any changes with OSA or Central apnea when treating cardiac patients with ionotropic, chronotropic medications?

Thanks Dr. Park, I did get that and am looking forward to reviewing it.

Thanks Dr. Park. Well worth the time, energy and expense.

Mary Z.

Thanks Dr Park. I did decide my attitude was out of line. Please blame it on chronic irritability (just lately) and sticker shock. Still I would be interested in what your consult consists of.
I did delete the comment as unnecessarily antagonistic. My humble apologies.

Mary Z.

And thank you re: the mp3 file. That was the first telecast I've really taken part in. I've never had much interest in youtube, twitter, myface and telecasts and online videos due to being a victim of slow speed dial up as our only available option in our rural area.

I so hope they will!!!! I've been absolutely enthralled w/DeVilbiss and F&P finally coming out w/fully data capable xPAPs! And delighted that PB has come out w/the new Sandman and would love to know more about them. Even tho I'm on bi-level. *sigh* I really LOVE my Resmeds and the ease of acess to so much data via the LCD screen. I really didin't lke the fussy access to the limited data on the Respironics. And I really HATED the power brick and platform of the Respironics too. The Resmed S8s have been such a CONVENIENT style, especially when traveling and changing motels each night. I was so sorely disappointed to see the S9s have the doggone extra cord and the power brick - two of the things I've hated most about the Respironics. I've got my fingers crossed that they will do a presentation for us!!!

And by the way - you sounded so YOUNG during the telecast!!!

Hello Dr. Park,

I got to the pdf with the link you provided and I'll get going on investigating all the info.

Thank you,
Renee
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At 12:38pm on March 24, 2010, Steven Y. Park, MD said… Sorry, I gave you the wrong link. Here's the right one: http://AttendThisEvent.com/?eventid=11869860.

On the upper left hand corner, you'll see a PDF link.

Hello Dr. Park,

I went to: http://doctorstevenpark.com/ - and I am not able to find a link for the PDF file. I looked under: Home, Sleep Apnea, Articles, Expert Interviews, Press Room, Resources and Contact Us. Am I going to the right website?

Thank you,
Renee
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At 9:13am on March 24, 2010, Steven Y. Park, MD said… Go to this website and there should be a link for the PDF file of Dr. Bhola's talk.
She gave a number of god reasons for deep sleep inefficiency.

I thought of another!!! One of more "general interest", I'm sure. How about a good RRT explaing the features of the various brand and models of xPAPs? Or maybe a manufacturer's Rep from the "majors" such as Resmed, Respironics, DeVilbiss, Puritan Bennet and Fisher & Paykel.

New xPAP users are almost never given any choice in xPAP they receive nor any choice of brand nor even aware that they can "shop" their local DME provider options their insurance is contracted with.

I take that back! But it might not have enough "mass appeal". I'm interested in the challenges of titrating and treating COPD patients w/CPAP and more importantly to me w/bi-level. I have a Resmed VPAP Auto (January 2008 release, not the Juy 2008 released VPAP Auto 25).

It didn't go too long for my taste at all!!! The scheduling of this presentation was great for me as I have a CD of two of my titrations PSGs. Her slides and explanations helped me go back thru the first one and better understand which "squiggly" line was which lead. The CD of the other study is an EAS file which I haven't been able to access yet. It was done on Resmed equipment w/Cadwell. I was told Cadwell would allow me access online but then was given the CD instead.

I'm not sure yet just what other subjects I'd like to see covered. By the way, I think I made a mistake last night or missed something. Doggone cat was buggig me to go out. I purchased the pdf but didn't get or download the mp3. Is the mp3 a separate purchase or did I just mess up?

Dr Park, I THOROUGHLY ENJOYED Dr Bhola's presentation last night. THANK YOU!

Hello Dr. Park

As I mentioned to you in my previous note, I am trying to get information on lack of S-3 and 4 (SWS), REM along with alpha intrusion - the possible causes, etc. I just got the report of my most recent (3rd) titration which took place on 2-23 and my S-3 went down further from 6.3% to 2.8% and my REM went down from 0.6% to 0.0%.

This evening I received a posting from Judy on SG suggesting I get a copy of the presentation by Dr. Bhola: "How To Read Your Sleep Study Report" since she discussed the lack of Stage 3 and REM.

And, so, following up on Judy's suggestion, I would like to know how I might be able to get a copy of the presentation from your interview.

Thank you,
Renee

Hello Dr. Park,

I very much appreciate your many postings of advice and support on SG and I would like to ask for your thoughts on a particular issue, that is, lack of S-3 and REM.

I was diagnosed with OSA and have been using CPAP since 12-09 and I am now using CPAP 7 nights a week.

My pressure has been increased from 9 to 12 and my OSA is improving.
Recent 6 wks at pressure of 12 – Per Hr – AI - .8; HI – 3.0; AHI – 3.8
1st 5 wks at the pressure of 9 – Per Hr – AI – 1.5; HI – 4.3; AHI – 5.8

However, I also have alpha intrusion and very little S-3 and REM.

S-3 & REM – % Of Sleep
2nd Titration – 1st Titration – 1st Sleep Study

S-1 – 42.9% – 68.2% – 35.6%
S-2 – 50.2% – 18.6% – 35.9%
S-3 – 6.3% – 6.5% – 20.2%
REM – 0.6% – 6.7% – 8.4%

After a 3rd titration on 2-23, I asked the tech in the morning and found that I, again, did not have REM sleep. I expect to go soon for a consultation to go over my latest titration results. However, on the morning after the titration, the doctor asked me to begin taking Gabapentin (Neurontin) 100mg at bedtime and I have been doing that for the past 10 days. (Although 100mg is a very low dosage, I also take Topomax 25mg daily for benign intention tremor and so that also needs to be taken into account.)

I was hoping that once I found out I had sleep apnea and used CPAP that it would be the answer I needed and, although I had a really difficult time adjusting to CPAP, I have persisted. But, with alpha intrusion and lack of S-3 and REM, I am not getting restorative sleep and so I remain incapacitatingly tired. And so I thought to ask if you have any thoughts or suggestions re: info / testing / treatment – any ideas regarding lack of S-3 and REM and related alpha intrusion.

Thank you very much for considering this long message on an individual issue and for any / all thoughts, suggestions or recommendations that you might have – as well as for all your on-going support and advise to SG members.

Best Regards,
Renee

Wonder what you think of this new treatment in clinical trials: http://www.sleepguide.com/forum/topics/imthera-tongue-implant-sleep

Hi Steve!

Susan McCord :-)